Measuring the full spectrum of health literacy: the validation of the Hungarian version of the Functional, Communicative and Critical Health Literacy scale (FCCHL-H) in a non-representative non-clinical sample
Abstract
Background: The majority of health literacy measures have been designed to measure functional levels of health literacy, while the FCCHL scale measures three levels of health literacy. The aim of this study was to validate the Hungarian version of the FCCHL scale and to investigate the relationship between the FCCHL subscales and sociodemographic factors.
Methodology: 399 adult subjects (117 males, 278 females and 4 non-binary subjects) with a mean age of 38,95 (SD=13,40) fullfilled the FCCHL-H scale and BHLS questions together with sociodemographic questions. A confirmatory factor analysis was used to examine the FCCHL-H questionnaire to determine whether the original three-factor structure could be replicated. In addition, we examined the convergent validity of the generated FCCHL-H questionnaire with the BHLS questions. Furthermore, we looked at the associations of different levels of health literacy with several sociodemographic characteristics using multiple regression analysis.
Results: The results of the confirmatory factor analysis showed that the original three-factor model of the FCCHL-H scale, with minor modifications, had a good fit (χ2(72)=167,22, p<0,001, CFI=0,957, TLI=0,945, RMSEA=0,058). The convergent validity of the FCCHL-H scale with the BHLS questions was supported by the significant, negative, week correlation between both the functional subscale and BHLS (r(397) = -0,351, p < 0,001) and FCCHL scale and BHLS (r(397) = -0,268, p < 0,001). The results of the regression analysis indicate that each subscale of the FCCHL-H scale is predicted differently by sociodemographic variables, confirming that the subscales measure different domains of health literacy.
Conclusions: Our results show that the reliability and structural validity of the Hungarian version of the FCCHL scale measuring different aspects of health literacy are adequate. The FCCHL scale allows for a rapid and comprehensive measurement of health literacy among both healthy individuals and patients and can thus be used for example in the preparation of prevention or patient education programmes. The study also presents possible directions for further research. It will also facilitate the measurement of different levels of health literacy and their interrelationships.
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